Finding Better Ways to Save Animals’ Lives

The days of the vet who can do it all — like the proverbial country doc who knew every detail of every patient and just how to treat them — are numbered. Especially in a big city like ours, where treating animals is a combo platter of urban policy, politics, outreach, statistics, and new views on clinical science.

Veterinarians thrive on figuring out the tough cases — using all our senses to perform a great physical and history, working out diagnostic options to treat each individual patient. That skill will never be obsolete. But there’s simply too much information out there for any lone-wolf vet to be the everything doctor for all domestic species. The largest issue — the number one “disease” of cats and dogs — is abandonment. Treating that illness takes not a lone wolf but a whole pack, a team. One of my favorite writers, surgeon Atal Guwande, would say it takes a pit crew.

If someone had told me when I entered vet school that I’d be stumping for strategies, systems, and protocols, I would have scoffed. But then I worked with the amazing people in RAVS, or Rural Area Veterinary Services, a non-profit that provides clinical instruction and free veterinary care in some of the poorest areas of the world (and exposes the next generation of vets to the plight of the rural poor and the need for community-based medicine). My RAVS colleagues were unique, hard-headed, brilliant individuals, but we had no trouble agreeing on this: the only way to ensure the best, most affordable care was to rein in our individual preferences and follow evidence based protocols.

In both human and veterinary medicine we are finding that boring numbers and protocols save money and lives. The data avalanche we live in is only going to get more intense, but the savviest practioners will learn to balance the art of practice with systems.

Not long ago I interviewed an experienced spay/neuter veterinarian for a post in our clinic. He asked if we would order a type of suture he liked to work with and that we didn’t stock. At the time we were performing 7,000 surgeries a year (now it’s more than 9,000), using protocols and procedures that our spay/neuter team had developed to improve patient safety, consistent care, and efficiency. Our chosen suture was less reactive and stronger than his preferred product. I told him we didn’t special-order sutures for surgeon preference, only for compelling medical reasons (of which a high-volume clinic has few). This surgeon told me, in effect, that he valued his right to practice medicine as he saw fit over our proven protocols and our goal of excellent subsidized surgical care. Our clinic had voted for better outcomes over medical autonomy.

Here’s another way we harnessed information: two years ago, we saw that 50 percent of the parvovirus cases coming in for subsidized treatment were from one ZIP code here in San Francisco. That ZIP code also had no veterinarian, and lots of cats and dogs there were being taken into the city shelter. We targeted this area with the Community Cares Initiative, starting a mobile clinic for free vaccinations and spay/neuter surgeries. Vaccinating against parvo is much cheaper than treating it, and the benefits of spay/neuter should be obvious. So far, the CCI has vaccinated almost a thousand dogs and spayed and neutered hundreds of animals no charge to their guardians.

And it’s a classic team effort. Our dedicated feral-cat volunteers worked with CCI staff to coordinate targeted trapping, leading to safe sterilizations for more than 300 cats in one of the most underserved areas in our city. Volunteers went door to door with fliers promoting no-cost spay/neuter and vaccinations. The mobile clinics also offered training and advice, even humane-education programs for kids.

The key was using data to identify the problem. It wasn’t that residents of that area loved their animals less or didn’t understand what they needed, but that they didn’t have access. They were inhibited by cost, lack of transportation, lack of time, in some cases language. This year we doubled the number of clinics and early indications are showing a payoff.

Medicine is only as good as your ability to give it. I learned that from my RAVS mentor, then-director Eric Davis, and it’s a theme you see in certain admirable, effective, hard-nosed organizations that are determined to provide excellent medical care for poor people, as well. The future of improving animal welfare is finding those creative providers who can make friends with the data, are willing to forego their ego for evidence based protocols, can get outside those mental and physical four walls of comfort, and prescribe a dose of teamwork.